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Patients with light chain myeloma have frequently a light chain tubular cast nephropathy, which can lead to severe renal impairment.

Both bortezomib and bendamustine have been identified as quickly acting, effective and well tolerated drugs and might therefore constitute an adequate combination regimen for patients with newly diagnosed/untreated light chain multiple myeloma.

Between September 2009 and March 2014, 20 patients with newly diagnosed/untreated light chain multiple myeloma were treated with bendamustine 60mg/qm on days 1 and 2, bortezomib 1.3 mg/qm on days 1,4,8 and 11, and prednisone 100mg on days 1,2,4,8 and 11 once every 21 days. 5 patients (25%) had a moderate or severe renal dysfunction (eGFR 15–59ml/min) and 9 patients (45%) a renal failure/dialysis (eGFR <15ml/min).

The median number of the BPV-treatment was 2 (1-5) cycles. 19 patients (95%) responded after at least one cycle of chemotherapy with 3sCR, 4nCR, 5VGPR, and 7PR. The myeloma light chains decreased rapidly, reaching the best response after the first cycle in 8 and after the second cycle in additional 9 patients.

16 patients discontinued therapy after median 2 cycles of BPV treatment to receive autologous (n=13) or autologous/allogeneic SCT (n=3). All together 10/14 patients with at least moderate renal failure improved their renal function (4CRrenal, 2PRrenal, 4MRrenal). 3 of the 6 dialysis-dependent patients became dialysis-independent.

With a median follow up of 23 months of the surviving patients, median PFS and OS for patients at 24 months were 90% and 95%, respectively. The most common severe side effect was grade 3-4 leukocytopenia in 25% of the patients. Grade 3-4 thrombocytopenia was observed in 15% of the patients. Moderate to severe infection were seen in 4 patients.

We conclude that BPV is effective and well tolerated in patients with newly diagnosed/untreated light chain multiple myeloma.